Bilingual Preschooler Referred for Language Delay
A 5-year-old girl is referred by her kindergarten teacher for a speech-language evaluation. She speaks Spanish with her parents and grandparents at home and began English exposure at age 3 when she entered preschool. Her English expressive vocabulary is at the 10th percentile on a monolingual English normed test; Spanish vocabulary is at the 35th percentile. She code-switches frequently, omits past-tense markers in English, and has difficulty retelling a story in either language. Her hearing is normal. She has no history of ear infections or neurological problems. The parents ask whether she has a language disorder or is simply 'confused' by two languages. She has been in an English-only classroom for 2 years. Her teacher reports that she is socially engaged and uses gestures to compensate.
1. What assessment approach would best differentiate a language disorder from sequential bilingualism? Include specific measures.
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Reasoning: Assess both languages, not just English, and use conceptual scoring so that a concept known in either language counts once. Obtain a detailed language history: age of first exposure, current exposure hours, home language use, and opportunities to hear and speak each language. Use measures less biased by exposure: nonword repetition, sentence repetition, and narrative retelling scored for macrostructure and grammar. Compare the child with bilingual norms, not monolingual norms, and gather parent and teacher reports. A true disorder should appear in both languages and across tasks; sequential bilingualism alone should show a profile that follows exposure, with stronger skills in the dominant language and normal code-switching.
2. Interpret the pattern: English 10th percentile, Spanish 35th percentile, code-switching, and difficulty retelling in both. Does this support disorder?
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Reasoning: The pattern is concerning but not conclusive. English at the 10th percentile is expected to be lower than Spanish because English exposure began at age 3; the Spanish score at the 35th percentile is also low, but the test may be monolingual-normed and not reflect her dialect or conceptual knowledge. Code-switching is normal in bilingual children and is not a sign of confusion. The strongest red flag is difficulty retelling a story in both languages: narratives tax vocabulary, grammar, and organization, and a cross-linguistic deficit is less easily explained by exposure alone. I would want conceptual scoring, bilingual norms, and a language sample. If the deficit persists in both languages after exposure is accounted for, a developmental language disorder is likely.
3. What would you advise the parents about maintaining Spanish at home?
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Reasoning: Advise them to continue speaking Spanish at home. There is no evidence that bilingual input causes language disorder, and reducing the home language can weaken the child's overall language foundation and family communication. The child should receive support in both languages, with explicit vocabulary and narrative intervention in the language of instruction and continued rich Spanish input. The parents can use shared book reading, extended conversation, and storytelling in Spanish. The school should not recommend 'English only' as a treatment; that practice is not supported and can reduce the child's access to academic content and identity. Monitor progress with bilingual assessment.